Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | G51105 | CA |
NPI | 1346453628 |
---|---|
Provider Name | Dr. Charles Maletz |
First Address | La Jolla, CA 92093-0001 |
Second Address | La Jolla, CA 92093-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 25/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
011507299078 | ME# (01) | CA |